<div class="row">
	<div class="col-sm-6">
		<section class="panel">
			<header class="bg-success panel-heading font-bold" style="background-color:#6c0a00"> Tambah Biodata Pengguna </header>
			<div class="panel-body">
			
				<form class="form-horizontal" action="<?php echo site_url('admin/aduserm/input')?>" method="post" class="panel-body">
				
					<div class="form-group">
						<label class="col-sm-4 control-label">Nama lengkap</label>
						<div class="col-sm-7">
							<input type="text" name="nama_lengkap" class="form-control" data-required="true" required>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">NIP</label>
						<div class="col-sm-7">
							<input type="text" name="NIP" class="form-control" data-required="true" required>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Tempat lahir</label>
					<div class="col-sm-7">
						<input type="text" name="tempat_lahir" class="form-control" data-required="true">
					</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Tanggal lahir</label>
						<div class="col-sm-7">
							<input class="datepicker-input form-control" name="tanggal_lahir" data-required="true" type="text" data-date-format="dd-mm-yyyy">
						</div>
						
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Jenis kelamin</label>
						<div class="col-sm-7">
							<div class="radio-inline">
								<label>
									<input type="radio" name="jenis_kelamin" id="optionsRadios1" value="1" checked required>
									Laki-laki
								</label>
							</div>
							<div class="radio-inline">
								<label>
									<input type="radio" name="jenis_kelamin" id="optionsRadios2" value="2" required>
									Perempuan
								</label>
							</div>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
						<label class="col-sm-4 control-label">Alamat</label>
						<div class="col-sm-7">
							<input type="text" name="Alamat" class="form-control" data-required="true">
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nomor telepon</label>
						<div class="col-sm-7">
							<input type="text" name="nomor_telepon" class="form-control" data-required="true">
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-4 control-label">Nomor handphone</label>
						<div class="col-sm-7">
							<input type="text" name="hp" class="form-control" data-required="true">
						</div>
					</div>
				
			</div>
		</section>	
	</div>
	<div class="col-sm-6">
		<section class="panel">
			<header class="bg-success panel-heading font-bold" style="background-color:#6c0a00"> Data Sign in </header>
			
				
			<div class="panel-body">
				<div class="form-horizontal" >
				
					<div class="form-group">
						<label class="col-sm-2 control-label">Email</label>
						<div class="col-sm-9">
							<input type="email" name="email" class="form-control" data-required="true" value="abc@abc.com" required>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-2 control-label">Username</label>
						<div class="col-sm-9">
							<input type="text" name="username" class="form-control" data-required="true" required>
						</div>
					</div>			
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-2 control-label">Password</label>
						<div class="col-sm-9">
							<input type="password" name="password" class="form-control" data-required="true" required>
						</div>
					</div>					
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-2 control-label">Role</label>
						<div class="col-sm-9">
							<select name="role" class="form-control m-b" required>
								<option>Pilih Role</option> 
								<option value="1">Administrator</option>
								<option value="2">Pencetak Legalisir</option>
								<option value="3">Verifikator</option>
								<!--<option value="4">Kepala Dinas</option>
								<option value="5">Sekretaris</option>-->
							</select>
						</div>
					</div>
					<div class="line line-dashed line-lg pull-in"></div>
					<div class="form-group">
						<label class="col-sm-2 control-label">Status</label>
						<div class="col-sm-9">
							<select name="status" class="form-control m-b">
								<option value="1">Aktif</option>
								<option value="0">Tidak Aktif</option>
							</select>
						</div>
					</div>
					<div class="form-group">			
						<div class="col-lg-11 control-label">
							<div class="doc-buttons">
								<a href="<?php echo site_url('admin/aduserm/userM');?>" class="btn btn-sm btn-info"><i class="fa fa-arrow-circle-left text"></i><span class="text"> Kembali</span></a>
								<!--<a href="<?php echo site_url('admin/aduserm/input');?>" class="btn btn-sm btn-info"><i class="fa fa-pencil text"></i><span class="text"> Simpan</span></a-->
								<input type="submit" class="btn btn-sm btn-info" value="Simpan"><i class="fa fa-pencil text"></i></input>
							</div>
						</div>				
					</div>						
				</form>
			</div>
		</section>	
		</div>
	</div>
</div>


